Suicide is the third leading cause of death in the 15-24 age group and accounts for more deaths than all natural causes combined. In 2007, 14.5% of U.S. high school students seriously considered suicide, 6.9% reported making at least one suicide attempt in the previous twelve months, and 2% of students reported making at least one suicide attempt in the previous twelve months that required medical attention. Despite the high public health significance of suicide and suicide attempts, there has been relatively little research devoted to developing or testing interventions that directly target suicidal behavior. There is no gold standard treatment for adolescent suicidality; reviews of published randomized controlled trials for adolescent suicidality conclude that treatments to date have been minimally efficacious. Thus, the consideration of new multi-modal interventions that can be applied to suicidal adolescents during the high risk transition period from inpatient to outpatient care, irrespective of diagnosis, is clearly warranted. The purpose of this R34 treatment development grant is to develop the Coping Long-term with Attempted Suicide Program - Adolescents (CLASP-A), an integrated, adjunctive intervention program for adolescents who have made a previous suicide attempt. The goals of CLASP-A are to reduce continued suicidal behavior and ideation, reduce risk behaviors for suicide, and improve adherence to psychosocial and psychopharmacologic treatments. It is comprised of three major components: a) three individual meetings while the patient is in the hospital, b) one in-person meeting with the patient and his/her parent/guardian in the hospital and c) a series of scheduled telephone contacts with the patient and parent/guardian for six months following discharge from the hospital. CLASP-A is based on a risk reduction model, and specifically targets four generic and potentially modifiable risk factors: hopelessness, impaired family support, problem solving deficits, and treatment non-adherence. The overall aim of this proposal is to further develop the CLASP-A intervention to address the needs of adolescents and to examine the feasibility and acceptability of this intervention program in adolescents. We propose a development phase which includes an open trial and iterative revisions to the treatment manual, a pilot study phase which includes a randomized trial (n=50), and a revision phase. Based on our findings, we will revise CLASP-A, with the objective of creating a flexible protocol in which emphasis can be shifted based on the presenting problems of the patient/family, and strategies can be selected to accommodate the developmental stage of the patient. The results from this pilot study will lay the groundwork for a larger clinical trial evaluating this new adjunctive intervention for suicidality for this high risk group of patients during the high risk period of transition from inpatient to outpatient care. PUBLIC HEALTH RELEVANCE: Adolescent suicidality is a growing public health concern. However, relatively little research has been devoted to developing or testing interventions that directly target suicidal behavior. The goal of this treatment development grant is to develop an adjunctive intervention for adolescents who have made a suicide attempt.